"a long way to go..."

About: Lancashire Care NHS Foundation Trust / Adult mental health

(as a service user),

I'm not going to go into great detail but during the last 6 years I have been under the care of LCFT, both as an inpatient and outpatient.

I have had mixed experiences but my opinion gives me particular concerns in regards to:

- treatment of people diagnosed (perhaps incorrectly) with borderline personality disorder.

- the overuse of the above disorder and what seems to be a lack of choice in treatment

- the crisis team - and the way that I believe they can't deal with a crisis

- on call psychiatrists and psychiatric liaison teams who have seemed to be to be narrow minded, unsympathetic and judgemental.

I know the trust has improved many of it's services but as I have written - it still has a long way to go on the above.

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Responses

Response from Lancashire Care NHS Foundation Trust

We are sorry to hear that your experiences have not been good to date. All Mental Health services should have taken on board the conclusions of the Sainsbury Centre's report 'No Longer a Diagnosis of Exclusion' which challenged the prevailing orthodoxy that people either had 'proper' mental illnesses or exhibited 'behaviour' sometimes labelled as attention seeking (as if seeking attention is in itself a bad thing to do)- which was not the true province of psychiatric services. This may in some way explain, but certainly not excuse, the attitudes of staff you have encountered.

The diagnostic category 'borderline personality disorder' has in the past had a rather pejorative usage, and has been used wrongly to dismiss people's legitimate distress and difficulty. Some people given the diagnosis are relieved to finally have an explanation of why life never seems to work out for them. Basically we see personality disorders as developing in reaction to early life difficulties, sometimes abusive, to which the child develops responses which at the time are adaptive - help them survive - but later in adulthood become counterproductive as the person applies early learning to adult life situations. As someone once said "every problem was a solution once"

In LCFT we are developing a Personality Disorder Managed Clinical Network to both develop treatment options but also as importantly to train and educate staff in more supportive, sensitive and informed ways of helping people with the diagnosis.

Whilst it may seem that the label is overused one alternative in the history of psychitaric care was that people were 'wrongly' diagnosed as suffering from Bi-Polar Mood Disorder (Manic Depression) and then given inappropriate treatment including unhelpful medications.

If you feel that you have specific complaints about the services you have received do by all means contact our Complaints Department. If you feel that you could contribute your expertise as a service user to assist LCFT to continue improving its services please do contact Katherine Allen our Adult network service user and carer involvement lead - katherine.allen@lancashirecare.nhs.uk

Update posted by switchy (a service user)

"We are sorry to hear that your experiences have not been good to date. All Mental Health services should have taken on board the conclusions of the Sainsbury Centre's report 'No Longer a Diagnosis of Exclusion'"

Some services within LCFT may have taken on board the conclusions of that report, but the services I use certainly don't seem like they have. I feel more stigmatised and discriminated against by so called 'professionals' than I do by society or those uneducated in mental health.

"Basically we see personality disorders as developing in reaction to early life difficulties, sometimes abusive, to which the child develops responses which at the time are adaptive - help them survive - but later in adulthood become counterproductive as the person applies early learning to adult life situations."

That's all very well, but why then is BPD not treated as a (normal) reaction to trauma? Why then am I not treated with empathy? Why then do I feel like I am being punished, treated as though this (apparent) disorder is my fault? The symptoms of BPD overlap with complex-PTSD, however the latter is seen as an understandable reaction to severe trauma (which I have suffered).

"In LCFT we are developing a Personality Disorder Managed Clinical Network to both develop treatment options but also as importantly to train and educate staff in more supportive, sensitive and informed ways of helping people with the diagnosis."

I don't doubt that you are, but something isn't working. Staff on the front line aren't changing. In fact, I would say they are getting worse. They seem so bogged down with frame works and pathways that they forget they are treating a human, a human who just happens to be very traumatised and hurt.

"Whilst it may seem that the label is overused one alternative in the history of psychitaric care was that people were 'wrongly' diagnosed as suffering from Bi-Polar Mood Disorder (Manic Depression) and then given inappropriate treatment including unhelpful medications."

I am aware that Bi-polar was sometimes incorrectly diagnosed in the past and I now think that is the case with BPD. I personally believe many people diagnosed with BPD are actually suffering from Complex-PTSD, but lets forget the diagnosis for a minute; I wouldn't care what label was stuck on me as long I was getting the correct (or at least some) help and support.

"If you feel that you have specific complaints about the services you have received do by all means contact our Complaints Department."

I have made complaints, both directly to the CMHT and also to the complaints department. I was not taken seriously, my complaints where overlooked and guess what, in the end it all boiled down to it being my problem... you know, my problematic personality.

Response from Lancashire Care NHS Foundation Trust

Thanks you for your further comments, they are very helpful for us in letting us know how much we have achieved and what else is needed as we work to improve the service that we offer to people with a diagnosis of personality disorder.

The approach to anyone’s care should be to use things like pathways as a means of guiding us to what the evidence suggests will be most helpful.

As you point out, at the core of any intervention, though, is a person and things like pathways are guidance to support that person.

It is a concern for us if you continue to have a negative experience of our services. Our complaints process does allow us to identify where we are getting things wrong on an individual process, and is one way for us to address this. While you have made complaints in the past, we would hope that if you still have concerns about your individual care and treatment, you raise these through our complaints process so that we can address them.